双胎妊娠孕期体质量对血清高敏C反应蛋白与妊娠期糖尿病关联的影响：一项队列研究

doi:10.19723/j.issn.1671-167X.2022.03.006

Abstract

Abstract:

Objective: To investigate the association between serum high sensitivity C-reaction protein (hsCRP) in early pregnancy and gestational diabetes mellitus (GDM) among twin pregnant women, and to explore the effects of the pre-pregnant body mass index (BMI) and gestational weight gain (GWG) status on such association. Methods: Twin pregnant women with pre-pregnant BMI greater than or equal to 18.5 kg/m² were recruited at Department of Obstetrics and Gynecology of Peking University Third Hospital from March 2017 to December 2020. Serum samples collected in early pregnancy were analyzed for hsCRP using particle-enhanced immunoturbidimetric method. In the following visits, the information about GWG and GDM were prospectively collected in every trimester. The association effect between hsCRP tertiles and GDM were estimated using Logistic regression, and further converted into risk ratio (RR). Cochran-Mantel-Haenszel test and mediation analysis were used to explore the effects of BMI and GWG status on the association. Results: Among the included 570 twin pregnant women, 31.6% deve-loped GDM, 26.1% were pre-pregnant overweight or obesity, and 49.5% with GWG out of referenced range. After adjustment for confounding factors, risk of developing GDM in twin gestations with the middle tertile and highest tertile of serum hsCRP in early pregnancy were 1.42 fold (95%CI: 1.02-1.89) and 1.54 fold (95%CI: 1.12-2.02), respectively, compared with the lowest tertile of serum hsCRP, and there existed significantly linear trend (P=0.022). Findings from mediation analysis illustrated that pre-pregnant BMI had partial mediating effect on the association, and BMI accounted for 23.84% (P < 0.001) of the increasing GDM risks with elevated hsCRP. Joint analysis with hsCRP and GWG found that those who were with GWG out of referenced range accompanied with the higher hsCRP tertiles (>1.21 mg/L) had significantly 2.31 fold increased risk according to those who were with GWG in the referenced range accompanied with the lowest hsCRP tertile (≤1.21 mg/L, P < 0.01). Conclusion: Elevated hsCRP in early pregnancy significantly increased GDM risk among twin pregnant women. The hsCRP-GDM association was dependent on GWG status, and pre-pregnant BMI had partial mediating effect on such association. It is suggested that twin pregnant women should consider systemic inflammation and gestational weight at the same time to reduce GDM risk.

Key words: Twin pregnancy, C-reactive protein, Diabetes, gestational, Body mass index

CLC Number:

R714.256

Yang-yang CHEN,Yu-bo ZHOU,Jing YANG,Yu-meng HUA,Peng-bo YUAN,Ai-ping LIU,Yuan WEI. Effects of gestational weight on the association between serum high sensitivity C reaction protein and gestational diabetes mellitus among twin gestations: A cohort study[J].Journal of Peking University (Health Sciences), 2022, 54(3): 427-433.

Figures/Tables 6

Table 1

Characteristics of twin pregnant women among hsCRP tertiles"

Items	Total (n=570)	T1 (n=178)	T2 (n=191)	T3 (n=201)	P
hsCRP/(mg/L), M (P₂₅, P₇₅)	1.94 (0.93, 4.21)	0.61 (0.64, 0.92)	1.86 (1.59, 2.33)	5.28 (3.99, 7.24)
Maternal age/years, M (P₂₅, P₇₅)	33 (31, 36)	32 (31, 36)	33 (31, 36)	34 (31, 36)
Nationality, n (%)					0.333
Han	526 (92.3)	166 (93.3)	179 (93.7)	181 (90.0)
Minority	44 (7.7)	12 (6.7)	12 (6.3)	20 (10.0)
Educational level, n (%)					< 0.001
High school and below	54 (9.5)	11 (6.2)	12 (6.3)	31 (15.4)^{ac, bc}
Bachelor	319 (56.0)	91 (51.1)	106 (55.5)	122 (60.7)
Master and above	197 (34.6)	76 (42.7)	73 (38.2)	48 (23.9)
Couple income per year (10 000 yuan), n (%)					0.128
< 12	141 (24.7)	36 (20.2)	42 (22.0)	63 (31.3)
≥12	103 (18.1)	35 (19.7)	32 (16.8)	36 (17.9)
≥20	139 (24.4)	46 (25.8)	45 (23.6)	48 (23.9)
≥30	187 (32.8)	61 (34.3)	72 (37.7)	54 (26.9)
Smoking (or passively), n (%)					0.483
No	467 (81.9)	146 (82.0)	161 (84.3)	160 (79.6)
Yes	103 (18.1)	32 (18.0)	30 (15.7)	41 (20.4)
Alcohol, n (%)					0.423
No	516 (90.5)	158 (88.8)	177 (92.7)	181 (90.0)
Yes	54 (9.5)	20 (11.2)	14 (7.3)	20 (10.0)
Pre-pregnant BMI, n (%)					< 0.001
Normal	421 (73.9)	154 (86.5)	150 (78.5)	117 (58.2)^{ac, bc}
Overweight or obesity	149 (26.1)	24 (13.5)	41 (21.5)	84 (41.8)
Parity, n (%)					0.954
0	484 (84.9)	152 (85.4)	161 (84.3)	171 (85.1)
1-	86 (15.1)	26 (14.6)	30 (15.7)	30 (14.9)
Aspirin use, n (%)					0.516
No	441 (77.4)	134 (75.3)	153 (80.1)	154 (76.6)
Yes	129 (22.6)	44 (24.7)	38 (19.9)	47 (23.4)
Conception mode, n (%)					0.052
Nature	161 (28.3)	59 (33.3)	57 (29.8)	45 (22.4)
Assisted reproductive technology	408 (71.7)	118 (66.7)	134 (70.2)	156 (77.6)
Chorionic, n (%)					0.870
Dichorionic	398 (75.2)	121 (73.8)	140 (76.1)	137 (75.7)
Monochorionic	131 (24.8)	43 (26.2)	44 (23.9)	44 (24.3)
Gestational weeks at blood drawing, M (P₂₅, P₇₅)	9 (8, 10)	8 (7, 10)	9 (8, 10)	9 (8, 10)^ac
Gestational weight gain, n (%)					0.256
In the range	228 (40.0)	73 (41.0)	80 (41.8)	75 (37.3)
Above the range	282 (49.5)	91 (51.1)	94 (49.2)	97 (48.3)
Below the range	60 (10.5)	14 (7.9)	17 (8.9)	29 (14.4)
GDM, n (%)					0.017
No	390 (68.4)	136 (76.4)	127 (66.5)	127 (63.2)^ac
Yes	180 (31.6)	42 (23.6)	64 (33.5)	74 (36.8)

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Table 2

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Figure 1

Table 5

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Model	Unadjusted				Adjusted
Model	T1	T2	T3	P_trend	T1	T2	T3	P_trend
Model 1	Ref.	1.42 (1.02, 1.88)^*	1.56 (1.15, 2.03)^**	0.015	Ref.	1.42 (1.02, 1.89)^**	1.54 (1.12, 2.02)^**	0.022
Model 2	Ref.	1.38 (0.99, 1.84)	1.41 (1.02, 1.88)^*	0.081	Ref.	1.38 (0.99, 1.85)	1.40 (1.00, 1.89)	0.089
Model 3	Ref.	1.44 (1.04, 1.91)^*	1.58 (1.17, 2.06)^**	0.012	Ref.	1.43 (1.03, 1.91)^*	1.55 (1.13, 2.04)^**	0.021

Items	Mediation of BMI on the association			Mediation of gestational weight gain on the association
Items	T1 vs. T2	T2 vs. T3	T1 vs. T3	T1 vs. T2	T2 vs. T3	T1 vs. T3
Total effect	0.099^* (0.003, 0.190)	0.028 (-0.074, 0.120)	0.127^*** (0.039, 0.210)	0.100 (-0.011, 0.180)	0.029 (-0.068, 0.100)	0.129^*** (0.037, 0.210)
Mediated effect	0.009^* (0.001, 0.020)	0.024^* (0.010, 0.050)	0.030^*** (0.004, 0.050)	0.001 (-0.007, 0.010)	0.006 (-0.001, 0.020)	0.006 (-0.001, 0.020)
Direct effect	0.091 (-0.004, 0.190)	0.005 (-0.103, 0.100)	0.097^* (0.017, 0.180)	0.099 (-0.010, 0.180)	0.023 (-0.076, 0.100)	0.122^*** (0.032, 0.200)
Proportion of mediation	8.59% (-0.002, 1.460)	83.80% (-4.980, 7.810)	23.84%^*** (0.049, 0.660)	0.76% (-0.085, 0.160)	20.54% (-1.124, 1.850)	4.77% (-0.016, 0.190)

hsCRP & gestational weight gain	n	Unadjusted	Adjusted
T1 & in the range	73	Reference	Reference
T1 & above the range	91	1.67 (0.95, 2.68)	1.66 (0.93, 2.68)
T1 & below the range	14	0.80 (0.13, 2.34)	0.78 (0.13, 2.29)
T2 & in the range	80	1.40 (0.75, 2.40)	1.39 (0.73, 2.38)
T2 & above the range	94	2.33 (1.46, 3.38)^***	2.31 (1.44, 3.36)^**
T2 & below the range	17	1.65 (0.59, 3.23)	1.66 (0.59, 3.24)
T3 & in the range	75	1.72 (0.96, 2.78)	1.68 (0.93, 2.74)
T3 & above the range	97	2.37 (1.50, 3.42)^***	2.31 (1.44, 3.37)^**
T3 & below the range	29	1.94 (0.92, 3.27)	1.90 (0.89, 3.24)

Effects of gestational weight on the association between serum high sensitivity C reaction protein and gestational diabetes mellitus among twin gestations: A cohort study

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hsCRP tertiles	BMI				Gestational weight gain status
	Normal		Overweight or obesity		In the range		Above the range		Below the range
	n	GDM, n (%)	n	GDM, n (%)	n	GDM, n (%)	n	GDM, n (%)	n	GDM, n (%)
Total	421	117 (27.79)	149	63 (42.28)	228	56 (24.56)	282	107 (37.94)	60	17 (28.33)
T1	154	35 (22.73)	24	7 (29.17)	73	13 (17.81)	91	27 (29.67)	14	2 (14.29)
T2	150	46 (30.67)	41	18 (43.90)	80	20 (25.00)	94	39 (41.49)	17	5 (29.41)
T3	117	36 (37.34)	84	38 (45.24)	75	23 (30.67)	97	41 (42.27)	29	10 (34.48)
	P_CMH=0.087				P_CMH=0.014

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